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PREDICTING PROSTATE CANCER–SPECIFIC MORTALITY

Identification of risk factors for prostate cancer–specific mortality
is the subject of 2 articles in this issue of JAMA. Freedland
and colleaguesArticle assessed prostate-specific antigen
doubling time (PSADT), pathological Gleason score, and time from surgery to
biochemical recurrence in a cohort of men who had received radical prostatectomy.
They found that these 3 clinical factors were useful for risk stratification.
D’Amico and colleaguesArticle examined the velocity
of PSA level increase in the year prior to diagnosis in men who received radiation
therapy. They found that a PSA velocity greater than 2.0 ng/mL was associated
with a shorter time to prostate cancer–specific mortality, even in men
with tumor characteristics suggestive of low-risk disease. In an editorial,
AnscherArticle discusses the clinical and research
utility of these findings.

ACUTE MI COMPLICATED BY CARDIOGENIC SHOCK

Early mechanical revascularization is recommended for patients with
acute myocardial infarction (MI) and cardiogenic shock for those who are younger
than 75 years, but whether this strategy has been adopted in routine practice
is not known. To assess trends in early revascularization and mortality for
patients with cardiogenic shock complicating acute MI, Babaev and colleagues
analyzed data from the National Registry of Myocardial Infarction from January
1995 to May 2004. They found that among hospitals with revascularization capability,
primary percutaneous coronary intervention rates increased from 27.4% to 54.4%,
and this was associated with improved survival.

ACUTE ILLNESS AND PESTICIDE EXPOSURE

Pesticides used on school grounds or on contiguous properties may pose
health risks for children and school employees. In an analysis of data from
3 national pesticide surveillance systems from 1998 to 2002, Alarcon and colleagues
estimated that pesticide exposure was a factor in 6.8 illnesses per million
children and 27.3 illnesses per million school employee full-time equivalents.
Illness severity was classified as low in the majority of cases, and insecticides
and disinfectants were implicated in two thirds of the reported events.

HYPERTENSION IN THE ELDERLY

Hypertension is common in elderly individuals, but few studies have
examined treatment, control, and risk factors among persons aged 80 years
and older. Using data from the Framingham Heart Study, Lloyd-Jones and colleagues
compared prevalence, treatment, and control of hypertension across age groups.
They found that hypertension prevalence increases with advancing age, exceeding
70% in those older than 80 years. Rates of control are low, particularly among
elderly women, and absolute risks for cardiovascular disease are markedly
increased among elderly persons with hypertension.

PREVENTIVE SERVICES FOR OLDER ADULTS

In an analysis of survey data from 3660 physicians and linked Medicare
claims data, Pham and colleagues found that the proportion of Medicare beneficiaries
receiving 6 preventive services was less than national goals. They identified
certain physician and practice-setting characteristics including medical school
location, practice size, access to information technology, and Medicaid revenues
that were associated with preventive care patterns.

CLINICIAN’S CORNER

VIRAL ENCEPHALITIS IN ORGAN RECIPIENTS

An article in the Archives of Neurology reports
clinical and autopsy findings from 4 recipients of organs and tissue from
a common donor who on postmortem examination was found to be infected with
the rabies virus. Roos discusses predonation testing of potential organ donors
with encephalitic illnesses.

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